Life Under Romneycare

It is the law that was the source code for Obamacare. It is the law that dare not speak its name. It also happens to be the best thing Mitt Romney will ever do in his life. Without it, I'm not sure how my family and I would live. Why would a man be ashamed of helping so many people?

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The portrait is large and it is richly detailed. It hangs in a place of some honor, where important people on important business in this very important place can see it as they sink into luxurious armchairs and wait for their important appointments with other important people. The portrait is of an unemployed man.

In the halls of the State House atop Beacon Hill in Boston, they hang portraits of the people who have governed the Commonwealth of Massachusetts since it was established in 1691, when the colonies of Plymouth and Massachusetts Bay were merged by royal decree into one political entity. You can trace the history of the commonwealth in the eyes of these men — and, except for one brief interregnum that will become relevant to our story later — they all have been men. You can trace that history in their collars. There is the long line of Puritan fathers, their brows like stalactites above their frozen eyes, as unyielding in their gaze as the God that drove them to this rocky and inhospitable place, their collars ruffled and stiff. There are the colonial governors, with their broad lapels and eyes narrowed with the suspicion that the world is changing around them. Gradually, waistcoats and cravats give way to morning clothes and bow ties. The faces become broader, the facial hair luxurious, as we move through the Civil War and the Gilded Age and into the twentieth century, when, remarkably, the ethnics begin to appear, and everybody wears the same tailored suits. Jim Curley. John Volpe. Michael Dukakis. The assimilated immigrant waves overwhelming the stern founders of the place in ways they never would understand. And, in a fine tailored suit, across from the portrait of Dukakis in the anteroom of the governor's office, hangs the portrait of the unemployed man.

He was not always unemployed. Once, for four years, he worked in this office, and that's why his picture is hanging where it is. In his portrait, he is handsome and chiseled and impeccable in all things. His hair is perfect. He is sitting on the corner of his desk, one foot on the floor, at once casual and in command. On the desk is a small framed portrait of his wife. Right next to it there is a blue binder, and his hand is resting near it, as though, through the artist, the unemployed man in the picture wanted your attention drawn to it because it is the most important thing in the picture besides the man himself. On the cover of the blue binder is a caduceus, the acknowledged symbol of the medical arts. That is where his hand is, so you don't miss the point.

The unemployed man is running for president this year. He is extraordinarily wealthy, but for a moment, let's pretend he's not. His wife has multiple sclerosis. He has grandchildren who were conceived and born through the technique of in vitro fertilization. All of this, the treatments and therapies for his wife, the technology that was required to give him his grandchildren, is extraordinarily expensive. If he were not extraordinarily wealthy — if he were, say, someone like me — and if he lived in two of the three states in which he has claimed residence, or owns a home, he would have a great deal of trouble getting health insurance for his wife. In only one of those places would that task have been made easier. That place is the Commonwealth of Massachusetts.

The reason for that is the blue binder that rests near his hand in the portrait that hangs on the wall. On April 12, 2006, in the sight of God and of Ted Kennedy, and of a guy from the conservative Heritage Foundation who'd been instrumental in guiding him to this moment on the stage in Faneuil Hall, Governor Mitt Romney of Massachusetts signed into law Chapter 58 of the Acts of 2006: an Act Providing Access to Affordable, Quality, Accountable Health Care. That was too hard for people to remember, so they fastened upon a nickname for it. They called it Romneycare.

It was his signature achievement as governor of the commonwealth — a market- based solution to the problem of access to quality health insurance that included an individual mandate requiring that people be insured. If it was determined that you could afford health insurance and you didn't buy it, you were assessed a penalty on your income taxes. The law has succeeded so well that six years into its implementation, 97 percent of the working-age adults in Massachusetts are covered by one form of health insurance or another, as are 99.8 percent of the children in the state. Before the law was passed, 67 percent of the businesses in the state offered health insurance to their employees. That number is up to 77 percent now. The program consistently polls at about 63 percent in its public approval. It has made thousands of lives easier, including my own.

There is chronic disease in my immediate family. Last fall, I left a job that provided health insurance and went back on the open market. I worked through the Health Connector and Commonwealth Choice, both of them programs set up in order to implement the 2006 law. There was a remarkable lack of red tape involved, and I was able to insure my family with as good a health-insurance plan as I could afford. Under the old system, at least one member of my family would have been uninsurable for reasons with which Mitt Romney is very familiar. I have a newly diagnosed condition that requires regular blood work and careful monitoring. You can measure this with money. Or you can measure it in worry and doubt and sleepless nights, with which far too many people in far too many places have to measure it. These are places like Utah, where Mitt Romney had a home but where he never was governor. These are places like California, where Mitt Romney has a home but where he never was governor. My life was made easier because I live in Massachusetts, where Mitt Romney has a home, and where he once was governor.

A few years back, I was in a place called Shishmaref, a barrier-island village in arctic Alaska that because of global climate change is slowly being devoured by the sea. The people there looked at the argument we were having over the very existence of the phenomenon that was chewing up their home, and they talked as though all of us in the lower forty-eight were out of our minds. That is very similar to the way that those of us in Massachusetts have looked at the campaign Mitt Romney has waged for president of the United States. To us, his health-care reform is close to an unalloyed triumph — a bipartisan solution to a serious problem, and a solution that has become a part of our daily lives. People talk about "the Connector" now the way they talk about the T, or the Sox. It's the kind of thing on which serious presidential campaigns are based. Hell, if it were about the effects of the health-care reform he helped shepherd through here, I'd do a commercial for him.

More to the political point, it is a solution that was borrowed almost wholesale by his opponent in the upcoming election, President Barack Obama, for what the president's partisans insist is the greatest domestic political achievement since the Great Society — the Affordable Care Act. If that is the case, then Mitt Romney would be well within his rights to assert that he had this idea first, and that he'd managed to get it passed without the kind of political bloodletting occasioned by the president's efforts. There was no uprising in Massachusetts over the individual mandate, no howling about "death panels." A popular bipartisan solution was devised to a vexing social problem, and Romney would be justified fully in basing his campaign purely on the fact that, in an era of gridlock and paralysis, he could get something like health-care reform done.

Instead, he has run away from it headlong. He has looked ridiculous in doing so, especially to many of the people in Massachusetts with whom he worked to get it passed. Once, after watching one of Romney's tortured explanations as to the difference between his plan and the president's, Jonathan Gruber, an MIT economist who'd worked on developing the Massachusetts plan, vented his frustration to a reporter from a New York–based online magazine.

"They're the same fucking bill," Gruber exploded.

It is something quite unprecedented. In 2008, John McCain memorably said at one point that he wouldn't vote for an immigration bill he'd previously sponsored, but that was late in the campaign and he was floundering. What Romney has been doing, however, is tantamount to George W. Bush's actively running for president in 2000 against the education reforms he'd signed in Texas as its governor. It is like Bill Clinton in 1992 disowning the entire state of Arkansas.

The difference, of course, is in the political party that Mitt Romney has had to court in order to become its nominee. Over the five years in which he has been running almost constantly for that nomination, Romney has seen his party move so far to the right so quickly that what once was a market-based solution to the problem of affordable health care, and one blessed by the Heritage Foundation at its birth, now represents the tyrannical bootheel of government on the throat of a free people. The individual mandate is the Alien and Sedition Acts. Mitt Romney has been elected to only one office in his lifetime. In that one office, he has one significant achievement. And to be nominated by his party, he has had to strangle rhetorically his darling.

It is curious, and quite sad, to watch. To those of us here, it is the very source of the thoroughly mendacious campaign he has run these past two years. To those of us here, he really has become quite a remarkable liar. He has been forced to prevaricate clumsily about all the genuine good his reform has done for the people of Massachusetts. (This started, by the way, long before the current campaign. In January of 2007, when he was winding up to run for president in 2008, Romney told a political forum that he had been "a little concerned" when Ted Kennedy had shown up for the bill signing that day in Faneuil Hall. Romney, of course, had invited the senator personally.)

His primary political necessity has been to lie about his primary political achievement. It has lodged in his campaign a fundamental dementia that has come to affect everything else. Once you lie about the good you've done, what does all the rest of it matter? He knows how well things worked out here, how very much easier he made my life and the lives of people worse off than me. What does he do now? Does he refuse our gratitude?

That's why when he posed for his portrait, the one that now hangs in the important office where the important people can see it while they wait for their important meetings, he made sure it was the blue binder with the caduceus on it that everybody noticed. He did not see this future coming. He knew what he wanted people most to remember about his time in that office.

"You know," says his successor as governor, Deval Patrick, with a canny old statehouse pol's twinkle, "you look at that picture and you know that somewhere in his heart, he's proud of what he did."

I am one of the lucky ones. A year ago, a job I'd taken nearly a decade earlier, primarily for the health-care benefits, became untenable. Even before that, the major corporation for which I worked had hardballed our fairly powerless union into rendering those very benefits a husk of what they once were. In this regard, the difference between your average major media corporation and your average, say, Walmart is not vast. Corporations are corporations, and they all behave in the same herd-like way.

It was interesting to watch how the membership of the union broke down on the issue of health-care benefits. The older members, like me, saw them as an essential part of a fundamental covenant between employer and employee. The benefits were something the company agreed to provide in exchange for salaries that might have been higher. That was the system in which we'd grown up. In many cases, that was the system into which our parents had bought, and it was part of the breathing room in the economy that had helped create the modern American middle class.

The younger members of the union — several of whom expressed serious doubts about the value of having a union at all — not only didn't seem to see the logic of this covenant, they didn't seem to see the covenant at all. The benefits were something that the Company provided for its own mysterious reasons, and if the Company wanted to claw some of them back, well, that was the Company taking back some of its own.

In any case, we started paying more and more of our own health-care costs, and we got shuttled into a new health-care provider that wasn't remotely as good as the previous one. I went along because of the situation within my own family, and the fact that I'd finally found a primary-care physician capable of partly overcoming my inbred medico-phobia.

(My mother, a survivor of polio, didn't go back to a doctor for more than fifty years. She dreaded them so that when my father developed Alzheimer's, she locked him away in her home rather than confront the issues. By the time we finally broke through to her, among her other medical problems she had a whopping skin cancer and toenails so long that they were photographed by the podiatrist for educational purposes. This kind of thing she handed down to me.)

There is an undeniable sense of being trapped in the system of employer-based health care, a powerful psychological screw for the employer to turn when the employer wants concessions in other areas, which it always does. A year or so later, when I became the target of a lethal combination of intellectual cowardice and grasping corporate brownnosing, working there became completely intolerable. One of the things necessary for my escape, however, was the knowledge that decent health insurance was available for my family at a marginally affordable price. I was one of the lucky ones. I lived in Massachusetts, and Mitt Romney once was my governor.

Jon Gruber is enthusiastically tucking into a salad at a restaurant west of Boston, and he's even more enthusiastically talking about the very first meeting he ever had with Mitt Romney on the subject of health-care reform.

"I'd been hired to develop the [health-care] plan, and the meeting was to decide whether or not he'd go forward with it. The meeting was Romney fighting with his political advisors. They were saying, 'Don't do this,' and Romney was saying that, no, it was the right thing to do. He was approaching it like an engineer, you know? He was saying, 'How can we make this work?' What was impressive was that he really wanted to solve a problem in the way that you'd hope a politician would try to solve a problem. He wanted to do the right thing, which is all I ever want from a politician. He was excited to do the right thing. I remember coming home and my wife, who was a big gay-marriage advocate, was saying how mad she was at Romney, and I told her, you may be, but he was pretty impressive on this."

Romney's mind was concentrated because, in 2005, with national ambitions percolating since his tenure running the Winter Olympics three years earlier, he really needed a win. He'd parachuted into Massachusetts, shoving aside the incumbent Republican governor, Jane Swift, the only woman in the line of stern portraits up at the State House. In 2004, he'd thrown all his influence behind a campaign to elect more Republicans to the state legislature. That had resulted in one of the most resounding failures in the political history of the commonwealth; the Republicans wound up with a net loss of three seats in both houses of the legislature. Shortly thereafter, Romney met with the editorial board of The Boston Globe and told them, "From now on, it's me-me-me."

At the same time, the national Republican party was groping for some sort of conservative market-based alternative to the rising call for an honest-to-goodness single-payer health-care system. The issue had been crucial to electing Democrats over the previous decade, and even with the failure of the Clinton administration's ambitious attempt to overhaul the system back in the early 1990s, it was plain that adherence to the status quo was not politically viable. These two dynamics came together in Massachusetts. In one of history's king ironies, given the distortions that Romney has made this year of the president's remarks about how no business is built all on its own, and given his tortured position that his health-care reform was really a triumph for states' rights, Governor Romney saw an opportunity to reform health care and burnish his national profile through the judicious use of ... federal money.

"Here was the deal," Gruber recalls. "Ted Kennedy was delivering $400 million in federal slush funds to our safety-net hospitals, Boston City and Cambridge Hospitals. President George W. Bush said, 'Why am I giving $400 million a year to Ted Kennedy? I'm taking that away.' Romney, to his credit, went to Bush's HHS and said, 'Instead of taking this money away, why don't we just use it to cover the uninsured?' And Bush, to his credit, said sure.

"That was the money that made all this happen — federal money. It was delivered by Ted Kennedy and then rededicated at the front end to cover the uninsured."

Gruber's plan had three elements: require anyone who could afford insurance to buy it, subsidize coverage for the working poor, and create some sort of "exchange" within which people could shop for the best insurance plan to suit their budget and their needs. "When I first presented it," Gruber explains, "it was like an economist's dream, a centrist Republican economist's dream. The law had two goals: to cover the uninsured and to fix a broken insurance market." And everyone agreed that the individual mandate, a conservative idea out of the Heritage Foundation, was critical to the success of the plan.

"Here's the thing," Gruber explains. "If you tell insurance companies that they have to cover anyone, and then you tell people they can wait until they get sick to buy insurance, insurance companies freak out. They raise their rates and it becomes a self-fulfilling prophecy. The rates get so high that nobody buys insurance. In Massachusetts, that totally killed our market. The first leg of reform is ending insurance- company discrimination, and for that, you need the mandate."

Romney then went all out to sell the plan.

So involved was Romney in the negotiations that he went to the homes of both the Speaker of the Massachusetts House and the president of the Massachusetts Senate and personally delivered letters asking them to work out some sort of compromise. Ultimately, after some ferocious back-and-forth between the principals, everyone got up onstage at Faneuil Hall and signed the bill. Gruber was so happy that in 2008, when he was advising Democratic campaigns and reporters called him for a quote about Romney, who'd already started backing away from the Massachusetts law, Gruber kept his mouth shut.

"I said, I'm not going to bad-mouth the guy, even when he started saying terrible things about Hillary's plan, and that was the same plan as his, too. That was disingenuous. He's never dealt with that inconsistency."

Gruber is not holding to his vow this time around. He is unsparing in his criticism of the ungainly dive Romney has taken on the program they worked together to fashion. "He had three choices, right?" Gruber says. "He could've done what Newt Gingrich did, which was to repudiate ever holding that position. Gingrich did that with the mandate. Or he could've said, I'm glad I did it in Massachusetts. Or he could've done what he did, which was to take this third ground and say it worked in Massachusetts, but it can't work nationally. The problem he has is that's a totally illogical position, and he looks like an idiot."

I truly had it easy, although my aversion to even the simplest paperwork complicated things more than a little. I left my previous job and I went through Commonwealth Choice, one of the two options presented by the health-care reform in Massachusetts. I wound up with a good family plan that covered my primary-care doctor and just happened to be the one that my old company had abandoned for cost-saving reasons after our last futile contract negotiations. My wife was covered, no questions asked. My son, fresh out of grad school, was able to stay on my plan until he was twenty-six.

Every one of those elements I mentioned that I obtained through Commonwealth Choice would have been a nightmare all its own. How do I get covered? Is my wife insurable? What does my son do as he tries to find work in a battered economy? What if I didn't make the kind of money I make? What then? It's a wilderness of emotional quicksand, and there are almost fifty million Americans still trying to make their way through it while even the most modest attempt to do for the country what Romney did for Massachusetts gets heckled from the peanut gallery, often by Romney himself.

Well, if I lived in Massachusetts, I could have signed up for Commonwealth Care, the other option presented by the law. If I lived in most of the rest of the country that Mitt Romney seeks to govern, I would be very much out of luck on all of this. I am one of the lucky ones. I had it easier. I live in Massachusetts.

Let us imagine, just for a moment, just as we imagined the unemployed man was not as wealthy as he is, that I was not as lucky as I am. In the first place, I could not have left the job that had become as miserable as a job can become. I would have had to stay, not because I was loyal to the company or devoted to my superiors or dedicated to the craft that I love and in which I had made a living for going on forty years now. I would have had to stay because the illness in my family made it impossible for me to leave. I would have clung to that miserable job like a life raft because the serious illness in my family made a catastrophic collapse into utter ruin no mere abstraction.

It is easy to say that I would have stayed for those reasons, even as the benefits locking me into a miserable job were trimmed and barbered on a regular basis, making the job even more miserable, because that's the way major corporations do things these days. It's easy to say that I would have done the right thing by all involved, and I very likely would have, but I would be lying if I didn't admit that there would have been moments when I resented myself for having been trapped like that, and that resentment would not have stayed internal. It would have found its way out, to my friends, to my family, to the bottom of a bottle of Jameson's. I never was going to be Hollis Brown or anything, but I wasn't all that far down the road from his farm. Really, today, in this economy, not many of us are.

But I had a way out. Because I was lucky. I live in Massachusetts, where we have Romneycare, you know.

The man who succeeded Mitt Romney as governor of Massachusetts thinks the portrait of his predecessor that hangs in his lobby is just one of the greatest things about the job. "I remember the day they came in here," Deval Patrick says. "They asked if they could use the desk, and I said of course. They even used the framed picture of Diane [Patrick's wife] and they put Ann Romney's face in the frame. And, of course, there's the health-care law."

It fell to Patrick, and to his incoming administration, to implement most of the new program. Romney left office in 2007, and in all honesty, he'd checked out of the job long before that. He was running for president full time, and he was traveling the country, telling conservative audiences what a terrible time he'd had being a Republican governor of a liberal hellhole like Massachusetts. Meanwhile, Patrick and his people set about the task of making Mitt Romney's one great accomplishment in office work.

"One of the things we had going for us," Patrick says, "is that everybody was on board. The political community, the business community, everyone. Even the small-business community. At the time, there were two problems plaguing small businesses: access to capital and the cost of health care. I talked to one guy who'd moved up here from Florida, and he'd just started a business and he said he'd moved here to do it because he had two small kids and he needed health care during the lean years when he was starting out. He told me he didn't want anyone going bankrupt if he got sick."

The rollout was a masterpiece of marketing. There was a series of television ads, slick and family friendly, explaining the mandate not as something punitive but as something we all did for one another in order to make the system work. "We've got it," said the mom at home with her daughter. "I'm getting it," said the yuppie on the bike. The state bought commercial time between the first and second inning of every Red Sox telecast during the summer of 2007, a season that ended in the team's second world championship in three years.

As the various parts of the system came online, the commercial began to feature people who had benefited from the reforms. One of the early stars was a woman named Jaclyn Michalos, whose breast cancer had gone undiagnosed because she hadn't been able to afford health insurance prior to finding it through the newly established Massachusetts Health Connector. Michalos was treated and remains cancer-free. Her poster hangs in the Connector's office to this day.

In short, because of the way it was sold to the public, the Massachusetts health-care-reform law ran into none of the superheated political problems that so bedeviled President Obama's passage of, as Jon Gruber would put it, the same fucking bill. "The issue was not politicized here," says Glen Shor, the executive director of the Connector. "It came out of a heavily Democratic legislature, pushed through by the leadership of a Republican governor. The business community was very supportive. There was no force out there driving public fear, and there never was."

Even the dreaded mandate was largely soft-pedaled through an intensive campaign of public relations and a generous appeals process that has decided in favor of people appealing the assessment of the tax penalty more than 60 percent of the time. "A classic example," Shor says. "People were scared that implementing an adult health-care mandate would result in a taxpayer revolt. They were concerned that people who already had insurance would react negatively when told they'd have to fill out a tax form giving some information to the state, and that there would be uninsured people who had to pay penalties, and there would be enough of an uproar to unravel the mandate." This, of course, is pretty much what happened in the country at large after the passage of the Affordable Care Act. Even the president runs merely on its most popular parts — the elimination of discrimination against those with preexisting conditions, the ability of children to stay on their parents' health insurance until the age of twenty-six. But even he stays away from the grand theory of it — that health care is a fundamental right, and something of a duty that we owe to one another, and that insuring everybody will save taxpayers an extraordinary amount of money over time. Patrick, one of President Obama's earliest and strongest political supporters, watched the circus with dismay.

"The administration did just a terrible job promoting health-care reform," Patrick explains. "They didn't give people a chance to get access to the benefits of the program." And, as always, that same bemused smile on his face, Patrick comes back to the portrait of the unemployed man who is now running for president.

"He was proud of it at the time," says the governor of Massachusetts. "Why wouldn't he be proud of it now?"

I have watched the entire presidential campaign in which Mitt Romney has run, and I have watched it from a very odd perspective. I have seen politicians who repeatedly change their positions on crucial issues the way Mitt Romney has. I have seen politicians who regularly mischaracterize their opponent's position, even egregiously, as Mitt Romney has. None of that surprises me anymore. But I can honestly say that Mitt Romney is the first political candidate I ever have seen consciously run away from the good he's done for thousands of people.

Here in Massachusetts, there are people like Jaclyn Michalos, who have the work of Mitt Romney to thank for being alive and well. There are 439,000 people who have health care now who didn't have it before because of the mechanisms that Mitt Romney helped devise and put into place. There are 150,000 patients using the state's community health centers who have kept their insurance even through the recent economic downturn because the Connector has worked the way that Jonathan Gruber and the rest of the people Mitt Romney tasked to put it together designed it to. Health-care costs are rising here, just as they are everywhere in the country, but at roughly the same rate, and the legislature recently acted to curb them within the context of the structure that Mitt Romney left behind.

And then there's someone like me, who was lucky enough to live in Massachusetts, where Mitt Romney once was governor, and who is lucky enough in his life to take full advantage of the system that Mitt Romney put in place, and who, because he is lucky in both those things, has been spared the financial insecurity and the fear and the doubt that Mitt Romney now says have to be part of the lives of our fellow citizens in the other states because the good he did here becomes tyranny if it spreads.

Because, while he never will admit it now, Mitt Romney depended in Massachusetts on the general sense of the people that we live in a commonwealth in the fullest and grandest definition of the term. Back in the day, when he was insisting on the individual mandate, he did so in the context of explaining it as a moral obligation on the part of citizens who could afford insurance to all their fellow citizens who might in some way have to foot the bill. This is what he said about the mandate at a press conference back in 2006:

"With regards to the mandate, the individual responsibility program which I proposed, I was very pleased to see that the compromise from the two houses includes the personal responsibility principle that is essential for bringing health-care costs down for everyone and getting everybody the health insurance they deserve and need."

So I wonder now how he has come to this unprecedented pass. How much is the presidency really worth to the man? How deeply do you have to scour your soul to eliminate the good you did for the people who elected you? How much of your conscience do you have to excise before there's not enough left to remind you that, once, you helped people? What kind of a man plays his own virtue for laughs and turns the better angels of his nature into carnival bozos above a dunk tank for the amusement of the rubes?

That is the place whence springs the fundamental dishonesty of the Romney campaign — the place where he somehow made the decision that the best thing he ever did in public life was the thing that would keep him from being president, and that the latter ambition was worth more than all the work that went into the former, and all the benefits that work produced. It is a fearsome, dead-hearted gamble with the soul. And it all, somehow, comes back to that portrait in the office of the governor of the Commonwealth of Massachusetts, and you see it now for what it really is. A moment in time deliberately destroyed by its subject, a still life, stillborn.